A Guide to Panic Disorder (Recurring Panic Attacks)

Panic disorder is a condition where you have recurring panic attacks. Many people with panic disorder also develop agoraphobia. This means you avoid many places, and may not even go out from your home, due to fear of having a panic attack in a public place. Treatment with antidepressant medicines and/or cognitive behaviour therapy works well in over half of cases.

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What is a panic attack?A panic attack is a severe attack of anxiety and fear which occurs suddenly, often without warning, and for no apparent reason. In addition to the anxiety, various other symptoms may also occur during a panic attack. These include one or more of the following:

•Palpitationsorathumpingheart.•Sweatingandtrembling.•Hotflushesorchills.•Feelingshortofbreath,sometimeswith choking sensations.•Chestpains.•Feelingsick.•Feelingdizzy,orfaint.•Fearofdyingorgoingcrazy.•Numbness,orpinsandneedles.•Feelingsofunreality,orbeingdetached from yourself.

The physical symptoms that occur with panic attacks do not mean there is a physicalproblemwiththeheart,chest,etc.Thesymptomsmainlyoccurbecauseofan ‘overdrive’ of nervous impulses from the braintovariouspartsofthebodyduringapanic attack.

During a panic attack you tend to over-breathe(hyperventilate).Ifyouover-breatheyou‘blowout’toomuchcarbondioxidewhichchangestheacidityintheblood.This can then cause more symptoms such as confusion and cramps, and make palpitations,dizziness,andpinsandneedles worse. This can make the attack seem even more frightening, and make you over-breatheevenmore,andsoon.

A panic attack usually lasts 5-10 minutes, butsometimestheycomein‘waves’forupto two hours.

What is panic disorder?At least 1 in 10 people have occasional panic attacks. If you have panic disorder it means that you have recurring panic attacks. The frequency of attacks can vary. About1in50peoplehavepanicdisorder.If you have panic disorder, you also have ongoingworryabouthavingfurtherattacksand/orworryaboutthesymptomsthatyougetduringattacks.Forexample,youmayworry that the palpitations or chest pains that you get with panic attacks are due to a seriousheartproblem.Somepeopleworrythat they may die during a panic attack.

What causes panic attacks?Panicattacksusuallyoccurfornoapparentreason.Thecauseisnotclear.Slightabnormalitiesinthebalanceofsomebrainchemicals(neurotransmitters)mayplayarole.Thisisprobablywhymedicinesusedfor treatment work well. Anyone can have apanicattack,buttheyalsotendtoruninsomefamilies.Stressfullifeeventssuchasbereavementmaysometimestriggerapanic attack.

Panic disorder, agoraphobia and other fearsSomepeoplewithpanicdisorderworryabouthavingapanicattackinapublicplace where it is difficult to get out of, or wherehelpmaynotbeavailable,orwhereitcanbeembarrassing.Thismaycauseyoutodevelopagoraphobia.About1in3people with panic disorder also develop agoraphobia.

Ifyouhaveagoraphobiayouhaveanumberoffearsofvariousplacesandsituations.So,forexample,youmaybeafraid to:

•beinanopenplace.•entershops,crowds,andpublicplaces.•travelintrains,buses,orplanes.•beonabridgeorlift.•beinacinema,restaurant,etcwhere there is no easy exit.•beanywherefarfromyourhome.Many peoplewithagoraphobiastayinsidetheir home for most or all of the time.

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You may also develop other irrational fears. Forexample,youmaythinkthatexerciseor certain foods cause the panic attacks. Becauseofthisyoumayfear(developaphobia)forcertainfoods,oravoidexercise, etc.

Dealing with a panic attackTo ease a panic attack, or to prevent one from getting worse:

•breatheasslowlyandasdeeplyasyou can.Concentrateonbreathing.

•breatheintoapaperbag.Bydoingthis youre-breatheyourowncarbondioxide. Thishelpstocorrectthebloodacidlevel thathadbeenupsetbyover-breathing which makes symptoms worse (describedabove). What is the treatment for panic attacks and panic disorder?Notreatmentisneededifyouhavejustanoccasional panic attack. It may help if you understandaboutpanicattacks.Thismayreassure you that any physical symptoms you get during a panic attack are not due to a physical disease. It may help to know how to deal with a panic attack.

Treatment can help if you have recurring attacks(panicdisorder).Themainaimoftreatmentistoreducethenumberandseverity of panic attacks.

Antidepressant medicinesAn antidepressant medicine is the usual treatment. These usually work well to prevent panic attacks in more than half ofcases.(Thesemedicinesareoftenusedtotreatdepression,buthavebeenfound to work well for panic disorder too, evenifyouarenotdepressed.)Theyworkbyinterferingwithbrainchemicals(neurotransmitters)suchasserotoninwhichmaybeinvolvedincausingsymptoms of panic.

•Antidepressantsdonotworkstraight away.Ittakes2-4weeksbeforetheir effectbuildsupandmaytakeuptoeight weekstoworkfully.Acommonproblem is that some people stop the medicine after a week or so as they feel that it is doing no good. You need to give them time to work.

Niamh | A Guide to Panic Disorder

•Antidepressantsarenottranquillisers, and are not usually addictive.

•Thereareseveraltypesof antidepressants, each with various ‘prosandcons’.Forexample,theydiffer intheirpossibleside-effects.However, SSRIantidepressants(selective serotoninreuptakeinhibitors)arethe ones most commonly used to treat panic disorder.

•Note:afterfirststartingan antidepressant, in some people some anxietysymptomsbecomeworsefora fewdaysbeforetheystarttoimprove.

If it works, it is usual to take an antidepressant for panic disorder for at least a year. At the end of a course of treatment, you should not stop an antidepressantsuddenly,butyoushouldreduce the dose gradually under the supervisionofadoctor.Inabouthalfofpeople who are successfully treated, there is a return of panic attacks when treatment is stopped. An option then is to take an antidepressant long-term. The attacks are less likely to return once you stop antidepressants if you have had a course ofCBT(seebelow).

Cognitive-behaviour therapy (CBT)This is a type of specialist ‘talking’ treatment.Itisprobablythemosteffectivetreatment.Studiesshowthatitworkswellfor over half of people with panic disorder (andagoraphobia).

•Cognitivetherapyisbasedontheidea that certain ways of thinking can trigger, or‘fuel’,certainmentalhealthproblems suchaspanicattacksandagoraphobia. The therapist helps you to understand your current thought patterns. In particular, to identify any harmful, unhelpful, and ‘false’ ideas or thoughts whichyouhave.Forexample,theideas thatyoumayhaveatthebeginningof apanicattack,wrongbeliefsaboutthe physical symptoms, how you react to the symptoms, etc. The aim is then to change your ways of thinking to avoid these ideas. Also to help your thought patternstobemorerealisticandhelpful. Therapy is usually done in weekly sessionsofabout50minuteseach, for several weeks.

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•Behaviourtherapyaimstochange behaviourswhichareharmfulornot helpful.Thismaybeparticularlyusefulif youhaveagoraphobiawithpanic disorder where you ‘avoid’ various situations or places. The therapist also teaches you how to control anxiety when you face up to the feared situations and places.Forexample,byusingbreathing techniques. •Cognitive-behaviourtherapy(CBT) is a mixture of the two where you may benefitfromchangingboththoughts andbehaviours.

IfyouhaveCBTanditworks,thelongtermoutlookmaybebetterthanwithtreatmentwithantidepressants.However,CBTisnotavailableineveryarea,anddoesnotsuiteveryone.

AcombinationofCBTandantidepressantsandmayworkbetterthaneithertreatmentalone.

Further help and informationNational Phobics SocietyZionCommunityResourceCentre,339StretfordRoad,Hulme,Manchester,M154ZYTelephone08701222325www.phobics-society.org.uk

A leading UK charity for anxiety disorders such as panic disorder, etc.

NO PANIC (National Organisation For Phobias, Anxiety, Neuroses, Information & Care)93BrandsFarmWay,RandlayTelford,ShropshireTF32JQHelpline08088080545www.nopanic.org.uk

First Steps to Freedom1TaylorClose,Kenilworth,Warwickshire,CV82LWHelpline08451202916www.first-steps.org

Forpeoplewithgeneralanxiety,phobias,obsessionalcompulsivedisorder,panicattacks,anorexiaandbulimia,andthosewho wish to come off tranquillisers. Servicesinclude,telephoneself-helpgroups,leaflets,booklets,videos,audiotapes including relaxation audio tapes.

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©EMIS2010,asdistributedonhttp://www.patient.co.uk/health/Panic-Disorder-(Recurring-Panic-Attacks).htmUsed with permission.

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